ChangeMakers Incident Form
Please allow us time to process and review your intake form. ChangeMakers will contact you using your preferred method. Appointments are made for Mondays only and are scheduled on first come first serve basis. Please email any court documents, photo evidence, letters, emails, etc. that pertain to your complaint to ChangeMakersFW@gmail.com after completing the intake form.

ChangeMakers Legal Team is committed to providing support to complainants which may include, but is not limited to:

-Providing information that complainants can use to address or remedy their situation
-Facilitating/participating in meetings & court dates (when available)
-Writing emails or letters
-Making phone calls on behalf of and/or in support of the complainant
-Referring for legal services
-Informing the community of legal injustices (Live videos, recorded videos, social media)

*CHANGEMAKERS DOES NOT GIVE LEGAL ADVICE*

CHANGEMAKERS MISSION STATEMENT
Our organization advocates for equity and justice for the Black community. Fort Wayne’s Black community has been historically marginalized, disenfranchised, and oppressed. We aim to educate, train, and activate organizers, individuals, groups, and businesses to invest in interrupting racism, bigotry, and prejudice whenever encountered.


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*
Please fill out the following form accurately and honestly.
Legal Name *
Birthdate *
YYYY
/
MM
/
DD
Phone Number *
Email *
Facebook name if different from Name listed above
Preferred Method of Contact *
Ethnicity *
Are you affiliated with any organizations in the city or elsewhere? (Example-NAACP Member) *
If you answered yes to the last question please list affiliations and titles below.
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